Research on Safety of Electronic Cigarettes
Slides from Dr. Konstantinos Farsalinos' presentation at the E-Cigarette Summit, London November 12, 2013.
Full summary of the E-Cigarette Summit: http://ecigarettereviewed.com/e-cigarette-summit-london-summary
The next social challenge to public health: the information environment.pptx
Research on Safety of Electronic Cigarettes - Dr. Konstantinos Farsalinos
1. Research on safety of
electronic cigarettes
Dr. Konstantinos Farsalinos
Researcher, Onassis Cardiac Surgery Center, Athens, Greece
Researcher, Department of Cardiovascular Diseases, University Hospital
Gathuisberg, Leuven, Belgium
2. E-cigarette facts
• New in the market
• Developed due to inefficiency of currently approved methods for
smoking cessation
• NRTs < 6% success rate (Moore et al., BMJ 2009)
• Oral medications < 20% success rate (Rigotti et al., Circulation
2010)
• Awareness and use growing exponentially
• Used by millions, mostly of young age (40 yo)
• Nicotine delivery, dealing with behavioral addiction
• No tobacco, no combustion
• Any regulation should be based on scientific evidence
5. Chemical studies
• Most commonly performed (mostly on liquids, fewer on
vapor)
• More than 300 analyses in Greece for presence of
TSNAs+PAH
• Provide indirect evidence on safety
• Findings depend on what you search for
• Flavorings used are GRAS for use in food
• We don’t know implications when inhaled
• Example of diacetyl -> bronchiolitis obliterans
9. Chemical studies
Overheating may lead to
production of toxic chemicals
Huge variety of devices, with different battery, liquid capacity and resistance.
HOWEVER, all were handled in the same way (2-seconds puff every 10 seconds)
Unrealistic conditions
Goniewicz et al, Tob Control 2013
20. Toxicology studies
Tests on vapor
Relative difference in viability between
cigarette smoke and worst-performing vapor
extract
Romagna, Farsalinos et al, Inhal Toxicol 2013
23. Toxicology studies
Tests on vapor
Myocardial cells
Untreated cells
E-cigarette
vapor treated
cells
Cigarette smoke
treated cells
Farsalinos et al, Int J Environm Res Public Health 2013
24. Toxicology studies
Cinnamon toxicity (?)
Tests on liquid
Irrelevant to e-cig
Approved
cinnamaldehyde dose
up to 4 x 10-2 M
(EPA, 2000)
Behar et al, Toxicol in Vitro 2013
27. Clinical studies
• Few studies performed on safety
• Long-term studies cannot be performed
• May get valuable information from studies on
pathophysiology of smoking-related disease,
immediate effects of use, short-term follow-up
and surveys
28. Clinical studies
Nicotine levels in e-cigarette unlikely to cause
overdose
•
•
•
•
Experienced e-cigarette users
5 minutes-13 puffs
Liquid consumption: 0.052 ± 0.13ml
Nicotine consumption: ≈ 1mg from 18mg/ml
nicotine-containing liquid
• Levels of nicotine absorption lower than
smoking (Dawkins et al, 2013)
Farsalinos et al, Subst Abuse 2013
29. Clinical studies
High nicotine levels
important in complete
substitution of
smoking (111 users)
Farsalinos et al, Subst Abuse 2013
30. Clinical studies
Effects on lung function
•No mention on changes in FEV1/FVC
•Could be due to short-term mechanical irritation and not damage
•Data from surveys report temporary cough as initial symptom
•No comparison with regular cigarettes
Vardavas et al, Chest 2012
41. Clinical studies
More to come…
• Effect on aortic elasticity (EUROECHO 2013)
• Effect on pulsed-wave velocity (measure of
arterial stiffness)
• Always comparison with tobacco cigarettes
42. Clinical studies
What we need to know
• Long-term safety cannot be assessed unless 10-15 years
have passed, because:
Smoking causes disease after many years of use
Current e-cigarette users are of young age (disease
incidence is very low in this population)
E-cigarette is a new product
43. Clinical studies
What we need to know
• Lung function:
Need to compare with tobacco cigarettes
Acute lung dysfunction may be caused by pure mechanical
irritation, which does not predict harm (e.g. cold weather)
Surveys have shown some irritation which is temporary, with
subsequent beneficial effects (subjectively perceived)
• Cardiac function:
Variety of mechanisms by which smoking causes disease
Some of smoking adverse effects take long time to reverse (e.g.
inflammatory markers)
44. Conclusions
• Although there are several chemical studies, few are performed on
vapor
• Need for more toxicology studies
• Need for studies on atomiser materials
• Protocol and device handling are the most crucial factors in getting
results applicable to real use
• Clinical studies are scarce; some already scheduled, need more
• Long-term studies impossible right now
Based on currently available data, it is reasonable to expect a
significant benefit for the health of smokers who switch from
tobacco to e-cigarette use, even in long-term users.
45. Conclusions
Research will help us define the best possible
materials in e-liquids and devices, which should
be done without killing variability and
innovation